In order to be marketed in the United States, all Medical Devices must be registered with the FDA. Manufacturing facilities are subjected to FDA inspections to ensure compliance with the American GMP requirements. In addition, each establishment where production, distribution, import and marketing of Medical Devices are performed in the U.S.A. must be disclosed and registered at the FDA, through Establishment Registration, in accordance with 21 CFR 807.

• CLASS I MEDICAL DEVICES
  Although some Class I devices are exempt from most QSR requirements, it is necessary to implement a Quality Management System (QMS) that conforms, at least partly, with 21 CFR 820. Even in the case of Class I devices that are exempt, the QMS must comply with the requirements of 21 CFR 820.180 (Record Keeping) and of 21 CFR 820.198 (Complaints File). As soon as the fees for the Establishment Registration are paid, the manufacturer can complete the device listing online process the for its Class I device.
• CLASS II MEDICAL DEVICES
  Require the implementation for a QMS compliant wtih 21 CFR 820. Clinical studies are required for innovative devices, thus it is important to get feedback from the FDA as early as possible by submitting a Pre-Submission (Pre-Sub) request. Subsequently, for devices that require clinical trials, it will be necessary to submit an application for Investigational Device Exemption (IDE) to allow the collection of data on the safety and efficacy of: implantable devices, devices that support and sustain vital functions, devices that play a fundamental role in the diagnosis, treatment and prevention of diseases, devices that present a potential risk to the health, safety and well-being of the subject. The preparation of the dossier for the IDE also involves the development of a protocol for the clinical study. For Class II Medical Devices that do not require clinical studies it will be necessary to prepare and send the 510(k) Premarket Notification and pay the related fee. FDA does not issue a certificate, but sends a letter that is published online (Marketing Clearance).
• CLASS III MEDICAL DEVICES
  It is necessary to implement a 21 CFR 820-compliant QMS. To obtain the marketing approval, it is necessary to submit an application for a Premarket Approval (PMA) and a pay fee. Based on the data provided by the manufacturer, FDA must determine whether the PMA contains valid and sufficient scientific evidence to ensure that the device is safe and effective for the intended uses. Moreover, FDA inspects all the operators involved in the design and production phase of the device to ascertain the compliance of the QMS with the QSR. Finally, if the PMA application is successful, FDA will communicate its approval for marketing the device. Each yearly quarter, FDA publishes the approved PMAs in the Federal Register. After obtaining the marketing approval or clearance from the FDA, each manufacturer must register their establishment through Establishment Registration, perform the Device Listing of devices marketed on the U.S. market and comply with the American GMPs. The Establishment Registration and the Device Listing entail the obligation for the manufacturer to designate a U.S. Agent and indicate the references of a device importer (U.S. Initial Importer).